Short-term outcomes following posterior cervical fusion among octogenarians with cervical spondylotic myelopathy: a NSQIP database analysis

Publication date: Available online 14 February 2018
Source:The Spine Journal
Author(s): Caroline E. Vonck, Joseph E. Tanenbaum, Thomas T. Bomberger, Edward C. Benzel, Jason W. Savage, Iain H. Kalfas, Thomas E. Mroz, Michael P. Steinmetz
BackgroundContext: Degenerative changes in the cervical spine occur in an age-dependent manner. As the U.S. population continues to age, the incidence of age-dependent, multi-level, degenerative cervical pathologies is expected to increase. Similarly, the average age of patients with cervical spondylotic myelopathy (CSM) will likely trend upward. Posterior cervical fusion (PCF) is often the treatment modality of choice in the management of multi-level cervical spine disease. Although outcomes following anterior cervical fusion for degenerative disease have been studied among older patients (aged 80 years and older), it is unknown if these results extend to octogenarian patients undergoing PCF for the surgical management of CSM.PurposeThe present study aimed to quantify surgical outcomes following PCF for the treatment of CSM among the octogenarian patient population, as compared to patients younger than 80 years old.Study Design/SettingThis was a retrospective study that used the National Surgical Quality Improvement Program (NSQIP).Patient SampleThe sample included patients aged 60-89 who had CSM and who underwent PCF from 2012-2014.Outcome MeasuresThe outcome measures were multi-morbidity, prolonged length of stay (LOS), discharge disposition (to home or skilled nursing/rehabilitation facility), 30-day all-cause readmission, and 30-day reoperation.MethodsThe NSQIP database was queried for CSM patients (International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] code 721.1) aged 60-89 who underwent PCF (Current Procedural Terminology [CPT] code 22600) from 2012-2014. Cohorts were defined by age group (60-69, 70-79, 80-89). Data were collected on gender, race, elective or emergent status, inpatient or outpatient status, where patients were admitted from (home versus skilled nursing facility), ASA class, comorbidities, and single- or multi-level fusion. After controlling for these variables, logistic regression analysis was used to compare outcome measures in the different age groups.Results819 patients with CSM who underwent PCF (416 aged 60-69, 320 aged 70-79, 83 aged 80-89) were identified from 2012-2014. 79.7% of PCF procedures were multi-level. There were no significant differences in the odds of multi-morbidity, prolonged LOS, readmission, or reoperation when comparing octogenarian patients with CSM to patients aged 60-69 or 70-79. Patients aged 60-69 and 70-79 were significantly more likely to be discharged to home than patients over 80 (OR 4.3, 95% CI 1.8-10.4, p<0.0001 and OR 2.7, 95% CI 1.1-6.4, p=0.0005, respectively).ConclusionsCompared to patients aged 60-69 and 70-79, octogenarian patients with CSM were significantly more likely to be discharged to a location other than home following PCF. After controlling for patient comorbidities and demographics, 80-89 year old CSM patients undergoing PCF did not differ in other outcomes when compared to the other age cohorts. These results can improve preoperative risk counseling and surgical decision-making.



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